in this situation, the patient or not used to it. -- the patient was not used to it. it would have been a different point of entry at our office. we knew her. we had access to records and we may not have treated her as aggressively. we do think that access is important. i would like to say something about the term primary-care physician. it was invented by a co-pay. i used to be called a general internist when i was in training. if you pay attention to what they call doctors, it is because we are getting ready to be changed the way we are paid. primary-care versus specialists have to do with one economic model to control costs. then it had to do with drg's and you created nocturnists. the specialist need to pay attention because they have changed their names again. they're being called proceduralists. that means that are getting ready to be whacked. a lot of times there is economic language underneath. term primary the care physician is such a bad thing because primary should be a good thing but it was not something i heard in training 20 years ago. i do not know what